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Purpose: For those who stutter, verbal communication is typically compromised in social situations. This may attract negative responses from listeners and stigmatization by society. These have the potential to impair health-related quality of life across a range of domains, including qualitative and quantitative impacts on speech output, mental health issues, and failure to attain educational and occupational potential. These systematic reviews were designed to explore this matter using traditional health economics perspectives of utility measures and cost of illness. Method: Studies were included if they involved children, adolescents, or adults with stuttering as a primary diagnosis. The quality of life search strategy identified 2,607 reports, of which three were included in the quality of life analysis. The cost of illness search strategy identified 3,778 reports, of which 39 were included in the cost of illness analysis. Results: Two of the three studies included in the quality of life analysis had a high risk of bias. When measured using utility scores, quality of life for people who stutter was in the range of those reported for chronic health conditions such as diabetes mellitus, cardiovascular disease, and cancer. However, there is little such evidence of quality of life impairment during the preschool years. Studies included in the cost of illness analysis carried considerable risk of bias overall. Conclusions: For people who stutter, there are substantive direct and indirect costs of illness. These include impairment, challenges, and distress across many domains throughout life, including income, education, employment, and social functioning. Evidence of quality of life impairment using utility measures is extremely limited. If this situation is not remedied, the lifetime impairment, challenges, and distress experienced by those who stutter cannot be documented in a form that can be used to influence health policy and health care spending. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the complexity of stuttering behavior. It described and classified the complexity of stuttering behavior in relation to age, behavioral treatment outcomes, stuttering severity, anxiety-related mental health, impact of stuttering, and gender. Method: For this study, a taxonomy was developed--LBDL-C7--which was based on the Lidcombe Behavioral Data Language of stuttering. It was used by five experienced judges to analyze the complexity of stuttering behavior for 84 adults and adolescents before and after speech restructuring treatment. Data were 3,100 stuttering moments, which were analyzed with nominal logistic regression. Results: The complexity of stuttering behavior appears not to change as a result of treatment, but it does appear to change with advancing age. Complexity of stuttering behavior was found to be independently associated with clinician stuttering severity scores but not with percentage of syllables stuttered or self-reported stuttering severity. Complexity of stuttering behavior was not associated with gender, anxiety, or impact of stuttering. Conclusion: Clinical and research applications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to answer three questions. (a) Does percentage of syllables stuttered (%SS) differ between standard and challenge phone calls. (b) Does anxiety differ between standard and challenge phone calls. (c) Is there a relationship between %SS and anxiety during standard and challenge phone calls? Method: Participants were 230 adults diagnosed with stuttering, who were participants from five clinical trials. Each participant received two 10-min phone calls at pretreatment and a further two phone calls 6 months or 20 weeks postrandomization. One phone call was standard, and the other presented challenge: occasionally disagreeing with, interrupting, and talking over participants, or asking for clarification of their views. Results: Statistically significant, but clinically minor, increases of %SS and anxiety occurred during the challenge phone calls. There was a statistically significant association between %SS and anxiety. Conclusions: Variable phone call procedures to assess stuttering severity in clinical trials are not likely to spuriously inflate or deflate treatment outcomes to a clinically important extent. Regardless, the present results suggest that there is statistical merit in controlling the nature of phone calls during clinical trials with the simple and replicable method developed in this report. Additionally, there is procedural merit in the challenge phone call procedure; it is a more valid representation of the challenges of everyday speech than the standard procedure. However, a disadvantage of the challenge phone call procedure is the practical issues associated with its use. The clinical and theoretical applications of the results are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Recent research has shown that some schoolage children who stutter may have speech-related anxiety. Given this, speech-language pathologists require robust measures to assess the psychological effects of stuttering during the school-age years. Accordingly, this systematic review aimed to explore available measures for assessing the psychological impacts of stuttering in young school-age children and to examine their measurement properties. Method: The systematic search protocol was registered with PROSPERO (ID: 163181). Seven online databases, in addition to manual searching and screening of reference lists, were used to identify appropriate measures for the population of children who stutter aged 7–12 years. The first two authors independently assessed the measures using the quality appraisal tool described by Terwee et al. (2007). Results: Despite the comprehensive search strategy, only six measures were identified for quality appraisal. No assessment tool was found to possess adequate measurement properties for the eight assessed domains: content validity, internal consistency, construct validity, reproducibility, reliability, responsiveness, floor and ceiling effects, and interpretability. No measure had clear evidence of responsiveness to clinical change. Based on the criterion defined by the Terwee et al. (2007) appraisal tool, the Communication Attitude Test and the Overall Assessment of the Speaker’s Experience of Stuttering for School-Age Children received the highest number of ratings in support of their measurement properties. Conclusions: The results highlight a lack of available measures in this domain and poor practices in developing and testing measurement instruments. To ensure that clinicians and researchers are equipped with sound measures to meet the mental health needs of this vulnerable population, further research to establish resources is needed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this review article is to provide an overview of the current evidence base for the behavioral management of stuttering and associated social anxiety. Method: We overview recent research about stuttering and social anxiety in the context of contemporary cognitive models of social anxiety disorder. That emerging evidence for self-focused attention and safety behavior use with those who stutter is considered in relation to current treatment approaches for stuttering: speech restructuring and social anxiety management. Results: The emerging information about social anxiety and stuttering suggests a conflict between the two clinical approaches. For those clients who wish to control their stuttering and where speech restructuring is deemed the most suitable approach, it is possible that speech restructuring may (a) induce or increase self-focused attention, (b) promote the use of safety behaviors, and (c) become a safety behavior itself. This conflict needs to be explored further within clinical and research contexts. Conclusions: The issues raised in this review article are complex. It appears that evidence-based speech treatment procedures are in conflict with current bestpractice treatment procedures that deal with social anxiety. In this review article, we propose directions for future research to inform the development of improved treatments for those who stutter and recommendations for interim clinical management of stuttering. [ABSTRACT FROM AUTHOR]

Purpose: In a companion paper, we found no statistical reason to favor percentage syllables stuttered (%SS) over parent-reported stuttering severity as a primary outcome measure for clinical trials of early stuttering. Hence, considering the logistical advantages of the latter measure, we recommended parent-reported stuttering severity for use as an outcome measure. The present report extends the prior analysis to a comparison of %SS with self-reported stuttering severity (SRSS) for use as an outcome measure in clinical trials of stuttering treatments for adults. Method: We analyzed data from four randomized clinical trials for adults that incorporated %SS and SRSS data at prerandomization and at 6 months post randomization. We analyzed the distributions associated with the two measures, their agreement, and their estimates of effect sizes. Results: The positively skewed distribution of %SS warrants much reservation about its value as a clinical trial outcome measure. This skew causes inherent instability because of spurious data associated with low scores, which occur commonly at the low end of such a distribution. This inherent instability is compounded by inherent problems with absolute reliability of %SS measures. These problems are reduced with the much more normal distribution of SRSS. Conclusions: The logistical arguments in favor of SRSS apply similarly to adults as they do when parents report the stuttering severity of their children. However, there are statistical reasons to favor SRSS over %SS measures as a primary outcome of clinical trials with adult participants: SRSS has acceptable discriminant validity and a normal distribution, and it is less error prone than %SS. We recommend SRSS as a primary outcome for clinical trials of adults with stuttering. [ABSTRACT FROM AUTHOR]

Purpose: iGlebe is an individualized, fully automated Internet cognitive behavior therapy (CBT) treatment program that requires no clinician contact. Phase I and II trials have demonstrated that it may be efficacious for treating the social anxiety commonly associated with stuttering. The present trial sought to establish whether the outcomes achieved by iGlebe are noninferior to those associated with in-clinic CBT from clinical psychologists. Method: Fifty adults with stuttering were randomized to receive in-clinic CBT for anxiety or 5 months online access to iGlebe. The design was a noninferiority randomized controlled trial with outcomes assessed at prerandomization and at 6 and 12 months postrandomization. Primary outcomes were CIDI-Auto-2.1 diagnoses for anxiety and mood disorders and Brief Fear of Negative Evaluation scale scores (Carleton, McCreary, Norton, & Asmundson, 2006). Secondary outcomes included speech, psychology, and quality-of-life measures. Results: Outcomes consistently showed clinically significant improvements of around a medium effect size for the cohort as a whole from prerandomization to 6 months postrandomization, which were maintained at 12 months postrandomization. Comparisons between the 2 treatments showed little difference between iGlebe and in-clinic treatment for all primary and secondary outcomes, with last observation carried forward for missing data. Conclusions: iGlebe is a promising individualized treatment for social anxiety for adults who stutter and offers a viable and inexpensive alternative to in-clinic CBT with clinical psychologists. An issue to emerge from this trial, which requires clarification during future clinical trials of iGlebe, is the posttreatment relation between percentage of syllables stuttered and self-reported stuttering severity ratings. [ABSTRACT FROM AUTHOR]

Purpose: This report investigates whether parent-reported stuttering severity ratings (SRs) provide similar estimates of effect size as percentage of syllables stuttered (%SS) for randomized trials of early stuttering treatment with preschool children. Method: Data sets from 3 randomized controlled trials of an early stuttering intervention were selected for analyses. Analyses included median changes and 95% confidence intervals per treatment group, Bland–Altman plots, analysis of covariance, and Spearman rho correlations. Results: Both SRs and %SS showed large effect sizes from pretreatment to follow-up, although correlations between the 2 measures were moderate at best. Absolute agreement between the 2 measures improved as percentage reduction of stuttering frequency and severity increased, probably due to innate measurement limitations for participants with low baseline severity. Analysis of covariance for the 3 trials showed consistent results. Conclusion: There is no statistical reason to favor %SS over parent-reported stuttering SRs as primary outcomes for clinical trials of early stuttering treatment. However, there are logistical reasons to favor parent-reported stuttering SRs. We conclude that parent-reported rating of the child’s typical stuttering severity for the week or month prior to each assessment is a justifiable alternative to %SS as a primary outcome measure in clinical trials of early stuttering treatment. [ABSTRACT FROM AUTHOR]

Purpose: For a community cohort of children confirmed to have stuttered by the age of 4 years, we report (a) the recovery rate from stuttering, (b) predictors of recovery, and (c) comorbidities at the age of 7 years. Method: This study was nested in the Early Language in Victoria Study. Predictors of stuttering recovery included child, family, and environmental measures and first-degree relative history of stuttering. Comorbidities examined at 7 years included temperament, language, nonverbal cognition, and health-related quality of life. Results: The recovery rate by the age of 7 years was 65%. Girls with stronger communication skills at the age of 2 years had higher odds of recovery (adjusted OR = 7.1, 95% CI [1.3, 37.9], p = .02), but similar effects were not evident for boys (adjusted OR = 0.5, 95% CI [0.3, 1.1], p = .10). At the age of 7 years, children who had recovered from stuttering were more likely to have stronger language skills than children whose stuttering persisted (p = .05). No evident differences were identified on other outcomes including nonverbal cognition, temperament and parent-reported quality of life. Conclusion: Overall, findings suggested that there may be associations between language ability and recovery from stuttering. Subsequent research is needed to explore the directionality of this relationship. [ABSTRACT FROM AUTHOR]

Purpose: Those who are socially anxious may use safety behaviors during feared social interactions to prevent negative outcomes. Safety behaviors are associated with anxiety maintenance and poorer treatment outcomes because they prevent fear extinction. Social anxiety disorder is often comorbid with stuttering. Speech pathologists reported in a recent publication (Helgadottir, Menzies, Onslow, Packman, & O'Brian, 2014a) that they often recommended procedures for clients that could be safety behaviors. This study investigated the self-reported use of safety behaviors by adults who stutter. Method: Participants were 133 adults who stutter enrolled in an online cognitive-behavior therapy program. Participants completed a questionnaire about their use of potential safety behaviors when anxious during social encounters. Correlations were computed between safety behaviors and pretreatment scores on measures of fear of negative evaluation and negative cognitions. Results: Of 133 participants, 132 reported that they used safety behaviors. Many of the safety behaviors correlated with higher scores for fear of negative evaluation and negative cognitions. Conclusions: Adults who stutter report using safety behaviors, and their use is associated with pretreatment fear of negative evaluation and unhelpful thoughts about stuttering. These results suggest that the negative effects of safety behaviors may extend to those who stutter, and further research is needed. [ABSTRACT FROM AUTHOR]

Purpose: A significant proportion of adults who stutter experience anxiety in social and speaking situations. The Unhelpful Thoughts and Beliefs About Stuttering (UTBAS) scales provide a comprehensive measure of the unhelpful cognitions associated with social anxiety in stuttering. However, reducing the number of UTBAS items would make it ideal as a brief screening instrument. Therefore, the aim of the present study was to develop a brief version of the full UTBAS scales. Method: The 66-item UTBAS scales were completed by 337 adults who stutter. Item reduction was used to determine a smaller set of items that could adequately reproduce the total score for each full UTBAS scale. Results: Item reduction resulted in the inclusion of six items for the brief UTBAS-6 scales. Decile ranges for scores on the brief UTBAS-6 provide reliable estimates of the full UTBAS scores and valuable clinical information about whether a psychological assessment is warranted. Conclusions: The brief UTBAS-6 provides a reliable and efficient means of screening the unhelpful thoughts and beliefs associated with speech-related anxiety among adults who stutter. Referral for a psychological assessment is recommended in cases where the UTBAS total score falls in or above the fifth decile. [ABSTRACT FROM AUTHOR]

Purpose: This study adds to the Lidcombe Program evidence base by comparing individual and group treatment of preschoolers who stutter. Method: A randomized controlled trial of 54 preschoolers was designed to establish whether group delivery outcomes were not inferior to the individual model. The group arm used a rolling group model, in which a new member entered an existing group each time a vacancy became available. Assessments were conducted prerandomization and 9 months and 18 months postrandomization. Results: There was no evidence of a difference between treatment arms for measures of weeks or clinic visits required, percent syllables stuttered, or parent severity ratings. However, children in the group arm consumed around half the number of speech-language pathologist hours compared with children treated individually. In addition, children in the group progressed more quickly after the treating speech-language pathologist became more practiced with the group model, suggesting the group results are conservative estimates. Conclusions: Group delivery of the Lidcombe Program is an efficacious alternative to the individual model. Parents responded favorably to the group model, and the treating speech-language pathologists found group treatment to be more taxing but clinically gratifying. [ABSTRACT FROM AUTHOR]

Purpose: Those with anxiety use safety behaviors when attempting to prevent negative outcomes. There is evidence that these behaviors contribute to the persistence of anxiety disorders. Safety behaviors have been prominent in the cognitive behavior therapy literature during the last decade, particularly with social phobia management. However, nothing is known of safety behavior use by those who stutter. This is surprising given the high prevalence of social phobia in the stuttering population who seek clinical help. Method: Clinical psychologists and speech-language pathologists (SLPs) created a list of safety behaviors that might be used by adults during treatment for stuttering. Participants were 160 SLPs who were asked whether they advised adults who stutter to use any of these safety behaviors. Results: SLPs commonly recommend safety behaviors during stuttering management. Factor structures were found for the following 5 safety behavior categories: (a) general safety behaviors, (b) practice and rehearsal, (c) general avoidance, (d) choosing safe and easy people, and (e) control-related safety behaviors. Conclusions: There is a need to determine the frequency with which adults who receive stuttering treatment follow these clinician recommendations. In addition, there is a need to experimentally determine whether following such recommendations prevents fear extinction at long-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Stuttering varies between and within speaking situations. In this study, the authors used statistical process control charts with 10 case studies to investigate variability of stuttering frequency. Method: Participants were 10 adults who stutter. The authors counted the percentage of syllables stuttered (%SS) for segments of their speech during different speaking activities over a 12-hr day. Results for each participant were plotted on control charts. Results: All participants showed marked variation around mean stuttering frequency. However, there was no pattern of that variation consistent across the 10 participants. According to control charts, the %SS scores of half the participants were indicative of unpredictable, out-of-control systems, and the %SS scores of the other half of the participants were not. Self-rated stuttering severity and communication satisfaction correlated significantly and intuitively with the number of times participants exceeded their upper control chart limits. Conclusions: Control charts are a useful method to study how %SS scores might be applied to the study of stuttering variability during research and clinical practice. However, the method presents some practical problems, and the authors discuss how those problems can be solved. Solving those problems would enable researchers and clinicians to better plan, conduct, and evaluate stuttering treatments. [ABSTRACT FROM AUTHOR]

Purpose: Researchers have used unscheduled telephone calls for many years during clinical trials to measure adult stuttering severity before and after treatment. Because variability is a hallmark of stuttering severity with adults, it is questionable whether an unscheduled telephone call is truly representative of their everyday speech. Method: The authors studied the speech of 9 men and 1 woman for a 12-hr day during different speaking activities. On that day and 1 week prior to that day, participants received an unscheduled 10-min telephone call from a person unknown to them. The authors compared the percent syllables stuttered (%SS) for the unscheduled telephone call on the day to the %SS of the unscheduled telephone call 1 week prior to the day and to the %SS during the entire day. Results: No significant differences were found, and all confidence intervals with t tests included 0. The concordance correlation test also showed a strong positive correlation between %SS scores for the entire day and for the unscheduled 10-min telephone call. Conclusion: The authors conclude that there is no reason to doubt that 10-min unscheduled telephone calls are a representative speech sample for %SS during clinical trials of stuttering treatments. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact on percentage of syllables stuttered of various durations of delayed auditory feedback (DAF), levels of frequency-altered feedback ( FAF), and masking auditory feedback (MAF) during conversational speech. Method: Eleven adults who stuttered produced 10-min conversational speech samples during a control condition and under 4 different combinations of DAF, FAF, and MAF. Participants also read aloud in a control condition with DAF and FAF. Results: A statistically significant difference was found between the NAF conversation condition and the 4 combined altered auditory feedback (AAF) conditions. No statistically significant differences in percentage of syllables stuttered were found in conversation or reading between the control conditions and the FAF/DAF or MAF conditions. The analysis of individual participants' data showed highly individual responsiveness to different conditions. Conclusions: Participants' varying responses to differing AAF settings likely accounted for the failure to find group differences between conditions. These results suggest that studies that use standard DAF and FAF settings for all participants are likely to underestimate any AAF effect. It is not yet possible to predict who will benefit from AAF devices in everyday situations and the extent of those benefits. [ABSTRACT FROM AUTHOR]

Objectives: Stuttering has been associated with a range of anxiety disorders, including social phobia. In the general community, anxiety disorders are frequently associated with increased rates of mood and substance use disorders. Therefore, in the present study, the authors sought to determine the rate of mood and substance use disorders among adults who stutter. Method: The study employed a matched case-control design. Participants included 92 adults seeking treatment for stuttering and 920 age- and gender-matched controls. Mental health assessments were conducted via a computerized psychiatric diagnostic interview. Conditional logistic regression models were used to estimate odds ratios for the prevalence of mood and substance use disorders in both groups. Results: When compared with matched controls, adults seeking treatment for stuttering had twofold increased odds of meeting criteria for a 12-month diagnosis of any mood disorder but were not found to report significantly higher lifetime prevalence rates for any substance use disorder. Conclusions: Although adults who stutter in the present study were characterized by significantly higher rates of mood disorders than matched controls, they do not appear to self-medicate with substances such as alcohol. Results are discussed in terms of treatment implications and possible reasons why adults who stutter may avoid alcohol. [ABSTRACT FROM AUTHOR]

Purpose: The aims of the present study were to (a) examine the rate of social phobia among adults who stutter, (b) study the effects of speech restructuring treatment on social anxiety, and (c) study the effects on anxiety and stuttering of a cognitive-behavior therapy (CBT) package for social anxiety. Method: Thirty-two adults with chronic stuttering were randomly allocated to receive either speech restructuring following a CBT package for social anxiety or speech restructuring alone. Data were obtained on a variety of speech and psychological measures at pre-treatment, post-CBT, post--speech restructuring, and 12 months follow-up. Results: Sixty percent of our cohort were diagnosed with social phobia. Speech restructuring treatment alone had no impact on the social phobia of our cohort at 12 months follow-up. At follow-up, participants who had received CBT showed no social phobia and greater improvements than control participants on a range of psychological measures of anxiety and avoidance. However, the CBT package made no difference to the speech outcomes of those with social phobia. Conclusion: The CBT treatment was associated with significant and sustained improvements in psychological functioning but did not improve fluency. [ABSTRACT FROM AUTHOR]

Purpose: This Phase I trial investigated the viability of telehealth delivery of the Camperdown Program with adults who stutter. This program involves speech restructuring. Method: All treatment was conducted remotely with participant--clinician contact occurring by telephone and e-mail. Results: Ten adults completed the program. The group showed an 82% reduction in stuttering frequency immediately after treatment and a 74% reduction 6 months after treatment. However, there was significant individual variation in response to the program. Conclusion: These preliminary data suggest that telehealth Camperdown has the potential to provide efficacious treatment for clients who do not have access to traditional face-to-face treatment. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to develop guidelines for the statistical analysis of percentage of syllables stuttered (%SS) data in stuttering research. Method: Data on %SS from various independent sources were used to develop a statistical model to describe this type of data. On the basis of this model, %SS data were simulated with varying means, standard deviations, and sample sizes. Four methods for analyzing %SS were compared. Results: Results suggested that %SS data can be adequately modeled with a gamma distribution. Simulations based on a gamma distribution showed that all 4 analysis techniques performed favorably with respect to Type I error except for F. E. Satterthwaite's (1946) t test, which had increased Type I error on two occasions. Power was generally lower for the Wilcoxon-Mann-Whitney test compared with the other methods. Analysis of variance (ANOVA) performed on square-root-transformed data performed adequately under all scenarios, but ANOVA performed on nontransformed data and Satterthwaite's t test performed poorly when sample sizes were small or when sample sizes and variances of the groups were markedly different. Conclusions: Standard techniques such as t test and ANOVA are appropriate for most analysis scenarios with %SS data. Two occasions when this is not the case are when sample size is small, with fewer than 20 in each group, or when sample sizes and variances of the groups are markedly different. Under these circumstances, analyses should be based on standard methods, with a suitable transformation performed prior to analysis. [ABSTRACT FROM AUTHOR]

A response by to a letter to the editor on the article "The Camperdown Program: Outcomes of a New Prolonged-Speech Treatment Model."

This study investigated the comparative reliability of 2 stuttering measurement tools when used by experienced judges: percentage of syllables stuttered (%SS) and a 9-point severity scale (SEV). The study also investigated the degree to which scores on 1 tool predict scores on the other and the distributions of stuttering when measured by these tools. Twelve experienced judges watched 3- min videotapes of 90 stuttering and 10 nonstuttering participants. Half the judges rated %SS, and half made severity ratings. Results showed very high intrajudge and interjudge agreement for both measures. There was a strong linear correlation between %SS scores and SEV scores. Based on this finding, it seems that the 2 measures can be regarded as largely interchangeable. The exception to this, however, was in cases where there was either a small number of significant fixed postures (blocks and prolongations) or a large number of innocuous repeated movements (repetitions) in the speech sample. In such cases, it appears that %SS and SEV scores combined would be needed to provide a valid measure of stuttering. SEV scores were more normally distributed than %SS scores, which were clearly skewed. The advantages and limitations of the SEV scale are discussed. [ABSTRACT FROM AUTHOR]

The Lidcombe Behavioral Data Language (LBDL; K. Bryant & A. Packman, 1999; A. Packman & M. Onslow, 1998; A. Packman, M. Onslow, & K. Bryant, 2000) is a recently developed taxonomy of stuttering. It fills a void in stuttering research because most current descriptive systems are taxonomies of disfluencies, not stuttering alone, and are not behaviorally based. This study is an investigation of intrajudge and interjudge agreement for the LBDL. Ten experienced speech-language pathologists and 10 undergraduate students received brief instruction in the LBDL and then applied it to 15 intervals of stuttered speech on 2 occasions. The speakers were children and adults. Intrajudge agreement was high for both groups but only experienced judges achieved satisfactory interjudge agreement. Results suggest that some stuttering behaviors may be easier to categorize than others. Possible applications of the LBDL to research and clinical practice in stuttering are discussed. [ABSTRACT FROM AUTHOR]

Considerable research has been directed at the outcomes of prolonged-speech (PS) treatment for the control of chronic stuttering, but little research to date has focused on the PS treatment process. This report examines a Stage 2 clinical trial of a reconceptualized PS treatment model known as the Camperdown Program. This program requires fewer clinician hours than traditional programs and has no formal transfer phase. Additionally, it incorporates the following treatment process innovations, which replace treatment process components that are intuitively and empirically problematic: (a) PS is taught without incorporating target behaviors in clinician instruction, (b) participants learn to control stuttering without programmed instruction, and (c) the treatment process does not involve clinician identification of stuttering moments. Thirty participants were initially enrolled in the trial. Final outcome data are presented for the 16 participants who completed all trial requirements, including 12 months posttreatment data collection. These 16 participants showed minimal or no stuttering in everyday speaking situations for up to 12 months after entering the maintenance program, with speech rates in the normal range. Speech naturalness and social validation data were also favorable. Although self-report data generally confirmed the speech data, the results were not as positive. The present outcomes were achieved in a mean of 20 hours of clinic attendance per participant, which is much fewer than the hours required by treatment programs reported recently that run intensively over 2-3 weeks. The promise of this Stage 2 clinical trial has led the authors to initiate a Stage 3 randomized controlled trial of the Camperdown Program. [ABSTRACT FROM AUTHOR]

Generalizability theory has been recommended as the most comprehensive method for assessing the reliability of observational data. It provides a framework for calculating the various sources of measurement error and allows further design of measurements for a particular purpose. This paper gives a practical illustration of how this method may be used in the analysis of observational data. We use the ratings of 15 unsophisticated raters using the 9-point speech naturalness scale of R. R. Martin, S. K. Haroldson, and K. A. Triden (1984) to evaluate the speech of adults before and after treatment for stuttering. We calculate various sources of measurement error and use these to estimate the minimum number of raters and ratings per rater for a reliable result. For posttreatment data, the average of three independent raters, and for pretreatment data, the average of five independent raters should give a result within one scale point of the hypothetical true score for the speaker in at least 80% of samples. The example illustrates the advantages of using this method of analysis. [ABSTRACT FROM AUTHOR]

Perceptual rating scales can be valid, reliable, and convenient tools for evaluating speech outcomes in research and clinical practice. However, they depend on the perceptions of observers. Too few raters may compromise accuracy, whereas too many would be inefficient. There is therefore a need to determine the minimum number of raters required for a reliable result. In this context, the ideas of Generalizability Theory have become increasingly popular in the behavioral sciences; suggestions have been made for their application to the assessment of speech-language disorders. Here we review the concepts involved, which are applied in a companion article dealing with speech naturalness data obtained from clients who recently completed treatment for their stuttering. We pay particular attention to the statistical requirements of the theory, including some cautions about possible inappropriate use of these techniques. We also offer a new interpretation of the results of the analysis that aims to be more meaningful to most speech-language pathologists. [ABSTRACT FROM AUTHOR]

This article reports the development of a tool for measuring how comfortable a person feels when communicating with someone who has undergone treatment for stuttering. The person rates the speaker on a 9-point Listener Comfort Scale (9 = extremely comfortable, 1 = extremely uncomfortable). In a preliminary investigation of the reliability and validity of the scale, 15 unsophisticated listeners rated video recordings of 10 adults before and after a prolonged-speech treatment for stuttering and of 10 matched controls. The results were compared with those of another 15 listeners who rated the same recordings with the widely used 9-point Speech Naturalness Scale (R. R. Martin, S. K. Haroldson, & K. A. Triden, 1984). Results showed that reliability of the Speech Naturalness Scale was superior to the Listener Comfort Scale, although users of both scales were able to distinguish between pretreatment speech, posttreatment speech, and the speech of controls. The results suggest that the Listener Comfort Scale captures information that is somewhat different than the information captured by the Speech Naturalness Scale. The authors concluded that the concept of listener comfort is a potentially useful additional way of investigating the social validity of behavioral treatments for stuttering. [ABSTRACT FROM AUTHOR]

The capacity to make reliable inductive statements about populations is critical for the advancement of scientific knowledge. An important contribution to that advancement of knowledge is determining that effects are either present or not present in populations. Statistical power is an important methodological qualification for any research that presents statistical results, and particularly so for research that presents null results. In this paper we describe the statistical concept of power, outline parameters of research that influence it, and demonstrate how it is calculated. With reference to selected published research, attention is drawn to the problems associated with a body of underpowered research, one being that population effects may go undetected. One way to prevent this problem is to calculate power a priori in planning research and include confidence intervals when presenting the results of research. However, it is difficult, if not impossible in many cases, to obtain high participant numbers for communication disorders of low prevalence such as stuttering. With this in mind, the paper concludes with an attempt to open discussion about ways to redress the problems associated with statistical power. [ABSTRACT FROM AUTHOR]

Discusses a study which investigated the relation of age, time since onset, gender and stuttering severity to treatment time in the Lidcombe Program. Subjects; Overview of treatment; Results.

Determines whether clinically significant stuttering reductions occur in school-age children under response-contingent time-out (TO) and whether any such reductions extinguish when TO conditions are removed. Acoustic changes associated with the reductions in stuttering; Behavioral effects of TO; Mechanisms uderlying responsiveness to TO.

Purpose: To respond to Dr. Ingham's letterto the editor, "Comments on Recent Developments in Stuttering Treatment Maintenance Research Using the Camperdown Program," which appears in this issue of the Journal of Speech, Language, and Hearing Research. Method: When a treatment program has a performance-contingent maintenance schedule, as the Camperdown Program has, participants vary greatly in the time taken to complete this schedule-up to 2 years or more, in some cases. We reject Dr. Ingham's position that outcomes be measured a year after individual participants conclude their maintenance for the very reasons he has argued many times in the literature. Conclusion: We will continue to measure the outcomes of our clinical trials after a clinically meaningful period and at the same time for all participants. [ABSTRACT FROM AUTHOR]

Comments on an article on the diagnosis of stuttering in children. Issues on subject selection; Issues on the weighting procedure used to measure stuttering-like disorders; Failure to distinguish between stuttering and speech disorders.